Table II.
Measures for mitigating the financial downturn and preparing for reopening during the COVID-19 pandemic
| Action item | Objective | Details and tasks |
|---|---|---|
| Backlogged procedures and visits | Tracking of each cancelled visit, vascular laboratory test, and procedure; maintain patient contact | Maintain contact and anticipate timing of calling patients depending on easing of each state lockdown; use a newsletter for medical information and telephone calls for reassurance; be ready to prioritize visits or procedures depending on individual circumstances and staffing |
| Billing and banking | Prepare for and update coding changes and for postpandemic changes; meeting with bank | Update electronic medical records and train staff for new codes and billing related to COVID-19; review collection accounts; if financial hardship occurred, consider talking to vendors about adjusting rent, utilities, and other expenses; access CMS “advance” payments (Table I); access bank line of credit, if needed |
| Clinical database | If not previously instituted, maintain complete database to include patient diagnoses, date of cancellation, urgency, and a log of patient contact | Will help in prioritizing visits and procedures when lockdown has lifted |
| Financial forecasting | Review weekly or biweekly data trends on cancelled visits and procedures, charge lag times; monitor cash flows, accounts receivables, denials, and write-offs | Reduce fixed costs and supplies; calculate revenue decrease based on anticipated patient volume and cancelled visits and procedures to estimate cash flow and whether to approach lender if necessary or free up personal resources; use historical collection data to compare against current collections; adjust budget according to ramping up volumes; will help in staffing needs |
| Employees | Support staff; termination or furloughing, if necessary | Transparency with employees about practice and offering support; if some employees must laid off or furloughed, maintain contact and/or provide some incentives for them to return once business has reopened to minimize losing them to other practices; if staff termination required, consider furloughing first; use financial forecasting to consider the options for critical staff needed |
| New revenue | New sources of revenue | Consider the Paycheck Protection Program; contact CMS for “advance” payments (Table I); consider working in intensive care units if hospital has shortage of critical care physicians; review ancillary services such as noninvasive testing to determine whether they can be ramped up by offering services to referring physicians or other tenants |
| Reopening | Strategies to prepare for reopening | https://www.ama-assn.org/delivering-care/public-health/covid-19-physician-practice-guide-reopening; https://www.mgma.com/resources/operations-management/covid-19-medical-practice-reopening-checklist; follow all state-mandated requirements for reopening; review and follow OSHA and CDC guidance |
| Telehealth | Use telehealth visits and learn the billing codes; monitor CMS and FCC sites for announcements | Determine which patient visits will be telehealth visits vs face to face; improve website and patient portal; to provide care, maintain contact with patients and document progress in database; monitor revenue from telehealth visits |
| Clinician well-being | Maintain personal well-being | Anxiety has been associated with COVID-19, even if for those not directly involved with infected patients; start or continue self-care while the crisis abates |
CDC, Centers for Disease Control and Prevention; CMS, Centers for Medicare and Medicaid Services; COVID-19, Coronavirus disease 2019; FCC, Federal Communications Commission; OSHA, Occupational Safety and Health Administration.